Dar es Salaam: From 100 patients to 65,000 in ten years

“We used to take care of our patients so they could die with dignity,” Professor Ferdinand Mugusi, MD of Muhimbili Hospital in Dar es Salaam told us last week. “Now our patients live. So thank you.”

Americans visiting medical settings in Tanzania, particularly when they are with United States Congressional staffers, get used to being thanked, because it was U.S. President’s Emergency Plan for AIDS Relief support that made the difference between life and death here. Dr. Mugusi started the first antiretroviral treatment clinic in Dar es Salaam in 2004, which, with help from PEPFAR quickly enrolled 100 people living with HIV. But Dr. Mugusi’s story doesn’t end there.

Today 65,000 people are enrolled in the HIV program, 60 percent of whom are on antiretroviral treatment, according to Dr. Mugusi. “If you provide this kind of care, you have to have facilities,” he said. You also need trained health workers, he added. Back when the first clinic began to give patients a reason to seek care, the government was confronted with the need to hire at least 10,000 more health workers, he said, adding, “I’m not sure the government has been able to do that.”

Volunteers from the Global Health Service Partnership, a joint endeavor of PEPFAR, the Peace Corps and Seed Global Health, a nonprofit that recruits physicians and nurses willing to serve, and raises funds to make it possible for some of them by paying medical school student loans, are helping train health care workers here, now for the second year in a row. Meeting the most frequently cited need we heard in Tanzania, where at most about five doctors serve every 100,000 people, it is a rewarding opportunity, because it makes a sustainable difference, those we met at Muhimbili last week said.

Nurses, whose role is all the more critical with the deficit of physicians “take a back seat here,” Kate York, a volunteer here to teach in the nursing school told us. The chance to teach them to take a stronger role, “creating leaders,” she said, was one of opportunities that drew her here.

Dr. Jeffrey Gates, a recently retired internist, now teaching in the medical school here knows “with education, it takes a long time to learn you made a difference.” He is patient. “I’m expecting 10, 15, 20 years from now, to see the difference.”

In the meantime, however, reality — the compromises that come in a country with too few medical and human resources — provides a somber balance to Dr. Mugusi’s success story and gratitude. They continue to affect choices of treatment for cancers, tuberculosis and hepatitis that often accompany HIV.

“There are things when you work in the U.S. that you take for granted,” he said. “Sometimes you wonder if you should take that biopsy, or send the patient home to die in peace.”